Is There a Correlation Between Irritable Bowel Syndrome and Lactose Intolerance?

Abstract

Irritable bowel syndrome (IBS) is a poorly understood gastrointestinal disorder that affects a significant percentage of the population and has a strong negative effect on the quality of life. The lack of known pathophysiologic mechanisms has made finding effective treatment strategies difficult. One of the common recommendations by clinicians is a trial of a lactosefree diet. We have wondered if there was sufficient evidence in the currently available literature to support such a recommendation. We have also looked into other possible relationships between malabsorption syndromes and IBS. All the articles used for this review have been found in the PubMed database. We have taken into consideration the possibility that there may be both genetic differences and differences in the gut microbiome between populations living in different geographic regions. Therefore, we have included articles from different geographic regions to increase the generalizability of the findings. While there is a plethora of evidence that IBS patients commonly report milk intolerance, we have not found any conclusive evidence to suggest an objective link between IBS and any known malabsorption syndromes, including lactose malabsorption. Furthermore, trials of lactase supplementation have not led to clinical benefit. We concluded that there was no evidence to support routinely recommending a lactose-free diet for patients diagnosed with IBS, but including hydrogen breath testing in routine workup of IBS is a reasonable clinical decision. Ultimately, we believe that more clinical trials and chemical studies of the feces are needed to determine the pathophysiology and explore possible dietary recommendations for patients with IBS.

Prevalence of Irritable Bowel Syndrome, Functional Dyspepsia and their Overlap in Bulgaria: a Population-Based Study

“…The role of food intolerance in inciting or exacerbating IBS symptoms has been well defined [44]. The meaningful association observed in our study of IBS in patients selfreporting milk intolerance is well established and in compliance with what has been reported in the literature.…”

“…The meaningful association observed in our study of IBS in patients selfreporting milk intolerance is well established and in compliance with what has been reported in the literature. There was a plethora of evidence that IBS patients commonly reported milk intolerance; however, in a recent review, Cancarevic et al [44] did not find any conclusive evidence to suggest an objective link between IBS and lactose malabsorption. Moreover, Vernia et al [45] concluded that there was a significant overlap between IBS and milk intolerance.…”

Diet and Nutrients in Gastrointestinal Chronic Diseases

“…Over 2/3 of IBS patients are convinced that their symptoms are associated with the intake of certain foods such as milk and its derivatives [ 79 ], leading some avoid such foods, with an estimated 12% risk of long-term nutritional deficits [ 80 ]. Nevertheless, no specific significant correlation was found in patients who reported certain foods or nutrients as triggers of intestinal symptoms [ 81 , 82 ]. Despite this, some foods seem to be associated with the generation of symptoms [ 4 , 83 ].…”

Global Dietary Patterns and Functional Gastrointestinal Disorders

“…The most commonly reported trigger for abdominal pain, bloating, diarrhea and distention in childhood is dairy [ 4 ]. The evidence for this is controversial and not sustained by the results of double blinded trials [ 5 ]. Other commonly reported triggers can include wheat products [ 6 ].…”